Family Medicine EOR Exam (NEW 2023/ 202
m m m m m m
4 Update) Questions and Verified Answers wit
m m m m m m
h Rationales| 100% Correct| Grade A
m m m m m
QUESTION
Am13-year-
old mgirlmpresentsmformhermschoolmphysical.mOnmexamination,myoumnoticemthemposteriormcurvaturemof m
hermthoracicmspinemtombemverymprominent mand mbulgingmbackward.mWhat mtypemof mdeformitymof mthem
spinemdoesmshemhave?
AmKyphosis
BmScoliokyphosis
CmScoliosis
DmLordosis
EmGibbus
Answer:
A
Kyphosismismamposteriormconvexmangulationmof mthemthoracicmspinemas mevaluated monmamsidemview.mE
xcessivemand mexaggerated mangulationmresultsminmcosmeticmproblems,mbackmpain, mand mcardio-
mrespiratorymproblems.mKyphosismmaymbempost-traumaticmormnon-
traumaticmtype.mScheuermann'smkyphosis,mpostural,mcongenital,mand mmetabolicmbonemdiseasemarema
mfew mof mthemnon-traumaticmcausesmof mkyphosis.
QUESTION
Am45-year-old mwomanmwithmam25-yearmhistorymof mtypemI mdiabetesmpresentsmformfollow-
upmof mhermdiabetes.mHermspot malbumin/creatininemratiomwasm100mmg/gm4mmonthsmago,mand mit mwasmc
onfirmed mat m100mmg/gmyesterday.mHermurinarymanalysismshowsmnomcells, mcasts,mormblood.mHermcrea
tininemism0.7mg/dl,mand mhermestimated mglomerularmfiltrationmratemism95m ml/min/1.73m2.mHow mwoul
d mhermproteinuriambemdescribed?
AmNormoalbuminuria
BmMicroalbuminuria
CmMinialbuminuria
DmMacroalbuminuria
EmNephroticmsyndrome
,Answer:
B
Screeningmformmicroalbuminuria,mam markermof mkidneymdisease,mism recommended mannuallymformpa
tientsmwithmtypemI mdiabetesmof mgreatermthanm5myearsmduration;mit mismrecommended mannuallymformall
mpatientsmwithmtypemII mdiabetes.mThismscreeningmtest mismmost measilymobtained mwithmamfirst mvoid mm
orningmurinem"spot"malbuminmtomcreatinine mratio.mNormalm levelsmformspot msamplesmarem<10m mg/gm
formmenmand m<15mmg/gmformwomen.mSincemkidneymdiseasesmothermthanmdiabeticmkidneymdiseasemm
aymcausemproteinuriamand malbuminuria,mevaluatingmthemurinemsediment mof mdiabeticsmwithmpresume
d mdiabeticmkidneymdiseasemismadvised.mMinialbuminuriamismnot mamtruemmedicalmterm.
QUESTION
Am55-year-old mwomanmwithmam15-yearmhistorymof mtypemII mdiabetesmpresentsmformfollow-
upmof mhermdiabetes.mHermspot malbumin/creatininemratiomwasm100mmg/gm4m monthsmagomand mwasmco
nfirmed mat m100mmg/gmyesterday.mHermurinarymanalysismshowsmnomcells,mcasts,mor mblood.mHermcreat
ininemism0.7mg/dlmand mhermestimated mglomerularmfiltrationmratemism95mml/min/1.73m2.mWhat mmedi
cation(s)mshould myoumprescribemtomhelpmprevent mhermprogressionmfrom mmicromtommacroalbuminur
iamand mtomhelpmprevent mamprogressivemdeclineminmglomerularmfiltrationmrate?
AmPotassiummchloride
BmCalciummcarbonate
CmLisinopril
DmSodiummbicarbonate
EmCalciummcitrate
Answer:
C
Lisinopril,manmACEmInhibitor,mshould mhelpmdecreasemalbuminuria,mprevent mprogressionmof mdiabetic
mkidneymdiseasemfrommmicromtommacroalbuminuria,mand mprevent mamdecline minmglomerular mfiltration
mrate.mThismclassmof mmedicationsmhasmbeenmstudied mextensivelymformthesempurposes.mAngiotensinmII
mreceptormblockersm(e.g.,mirbesartan)mmaymalsom reducemurinarym albuminmtomnormalm levels.
Monotherapymwithmeithermof mthesemclassesmof mmedicationsmshould mbemattempted mfirst minmpatientsm
withmmicroalbuminuria.mThismwillmtest mtolerance, meffectiveness,mand madversemreactionmsuchmasmhy
perkalemia.mFormpatientsmwithmgreatermdegreesmof malbuminuriam(e.g.,m1mg/day),mpoor mresponsemtom
monotherapymand mblood mpressuremcontrol,mand mnomhyperkalemiamassociated mwithmtherapy,mcombi
nationmtherapymshould mbemconsidered.mCombinationmtherapymwithmbothmACEminhibitorsm(e.g.,mlisi
nopril)mand mangiotensinmII mreceptormblockersm(e.g.,mirbesartan)mismused mtomtreat mbothmdiabeticmand m
non-
diabeticmkidneymdisease.mThesemmedicationsmact monmdifferent mpartsmof mthemreninmangiotensinmsyst
em.mInmcombination,mirbesartanmcould mblockmthemeffect mof mangiotensinmproduced mbymnon-
ACEmpathwaysmand mlisinoprilmcould mblockmthemproductionmof mangiotensinmstimulated mbymirbesart
anminmamnegativemfeedbackmsystem;mhowever,mcombinationmtherapymismusuallympreceded mbymmono
therapy.mAlthoughmcombinationmtherapymismcurrentlymbeingmused minmbothmdiabeticmand mnon-
diabeticmkidneymdisease,mthismtherapymstillmbeingmresearched.mIt mismunknownmwhethermmonothera
pymalonemis
,sufficient.mIt mdoesmnot mappearmtombemsufficient minmallmpatients,mparticularlymthosemwithmpersiste
nt mmicromand mmacroalbuminuriamdespitemmonotherapy.
QUESTION
Am7-year-old mboympresentsmwithmam1-
weekmhistorymof mwheezingmand mdyspneamonmanymexertionm(withmproductivemcough).mOnmphysicalme
xamination,mbilateralmrhonchimaremheard.mAftermamfew mdaysmof mtreatment,mspirometrymismdonemonmt
hempatient.mThemfindingsmaremshownminmthemtable.mTotalmlungmcapacitym(TLC)m ism111%monmspirome
try.mWhat mismthemmost mlikelymdiagnosis?
FVC%mbefore/aftermbronchodilators:m49/63mFEV1
%mbefore/aftermbronchodilators:m41/46mFEV1/FV
Cmbefore/aftermbronchodilators:m49/55
AmAsthma
BmPneumonia
CmPleuralmeffusion
DmKyphoscoliosis
EmTuberculosis
Answer:
A
Themspirometrymresult minmthismpatient mshowsmreductionminmbothmforced mvitalmcapacitym(FVC)mand
mforced mexpiratorymvolumeminm1msecond m(FEV1),mbut mFEV1mismmoremaffected mthanmFVC.mTheref
ore,mtheremismamdecreaseminmthemFEV1/FVCmratiombelow mthempredicted mlevels.mThemTLCmismnorm
alm(80-
m120%).mThismconcludesmthat mthismismanmobstructivemdisordermand mexcludesmthemrestrictivemdiseas
esmlisted.mTheremismammarked mimprovement mwithmbronchodilators.mInmreversiblemairwaymobstructi
onmsuchmasminmasthma,mtheremismamrisem inmthemFEV1mand/ormFVCmbymapproximatelym12% mfrommpr
e-mtompost-
bronchodilatormtesting.mThismreversibilitymismcharacteristicmof mbronchialmasthma. mThe mspirometr
ymfindingsmaremnot msuggestivemof mrestrictivemlungmdiseasesmsuchmasmpneumonia,mpleuralmeffusion
,mkyphoscoliosis,mand mtuberculosis.
QUESTION
Am29-year-
old mwomanminquiresmwhenmshemshould mhavemhermfirst mmammogram.mHermfamilymhistorymismsignifi
cant mformthemdeathmof mhermmothermand mgrandmothermduemtombreast mcancermat mthemagemof m32myears.
mPresently,mthemwomanmismasymptomatic.mWhat mismthemrecommendationmformmammographymformt
hismpatient?
If myoumhavemamstrongmfamilymhistory,mthemNationalmComprehensivemCancermNetworkmrecommends,
mstartingmat magem30,myoumget ma:
Clinicalmbreast mexammeverym6-12mmonths
, MammogrammeverymyearmBrea
st mMRI meverymyear
AmImmediately
BmWhenmshemism30myearsmold
CmWhenmshemism32myearsmold
DmWhenmshemism34myearsmold
EmWhenmshemism36myearsmold
Answer:
A
Breast mcancermismrecognized masmbothmanmincreasinglymcommonmdisordermand mampotentiallymheredita
rymdisorder.mFurthermore,mearlymdetectionmwillmprovidemamwomanmwithmhermbest mchancemat mamcurem
of mbreast mcancer.mGivenmthempatient'smgeneticmburdenmof mhavingmbothmhermmothermand mhermgrandm
othermdiemof mmetastaticmbreast mcancermat mthemrelativelymyoungmagemof m32myears,mit mismreasonablemto
mprovidemhermwithmimmediatemand mperiodicmmammographymcombined mwithminstructionminmbreast m
self-
mexamination.mWomenmat mhighmriskmrequirem ammoremaggressive mschedule,mfrequent mexaminations,
m and mothermproceduresmsuchmasmultrasound mand mMRI.mAmericanmCancermSocietymGuidelines
Womenmagesm40mtom44mshould mhavemthemchoicemtomstart mannualmbreast mcancermscreeningmwithmmam
mogramsmif mtheymwishmtomdomso.
Womenmagem45mtom54mshould mget mmammogramsmeverymyear.
Womenm55mand moldermshould mswitchmtommammogramsmeverym2myearsmormcanmcontinuemyearlymscre
ening.
Screeningmshould mcontinuemasmlongmasmamwomanmisminmgood mhealthmand mismexpected mtomlivem10mmor
emyearsmormlonger.
ThemACSmdoesmnot mrecommend mclinicalmbreast mexaminationmformbreast mcancermscreeningmamo
ngmaverage-riskmwomenmat manymage
ACOG mcontinuesmtomrecommend madherencemtomitsmcurrent mguidelines,mwhichmincludemthemfollowin
g:mScreeningmmammographymeverym1-2myearsmformwomenmaged m40-49myears
Screeningmmammographymeverymyearmformwomenmaged m50myearsmormolder
QUESTION
Am42-year-old mwomanmworksmfull-
timemasmamdatamentrymclerkmand moftenmputsminmmanymhoursmof movertime.mShemhasmstarted mtomnoticem
numbnessmand mtinglingminmhermright mthumb,mindexmfinger,mmiddlemfinger,mand mhalf mof mhermringmfin
ger;msymptomsmaremespeciallymseveremat mnight mThemnumbness mand mtinglingmwerem intermittent mform
months,mbut mtheymhavembecomempersistent mduringmthempast mfew mdays.mWhat mcould mbemconsidered m
ampredisposingmfactormformthismpatient'smcondition?
AmMyxedema
BmHypoadrenalism
CmHypoprolactinemia
DmHypoglycemia
EmCushingmsyndrome
m m m m m m
4 Update) Questions and Verified Answers wit
m m m m m m
h Rationales| 100% Correct| Grade A
m m m m m
QUESTION
Am13-year-
old mgirlmpresentsmformhermschoolmphysical.mOnmexamination,myoumnoticemthemposteriormcurvaturemof m
hermthoracicmspinemtombemverymprominent mand mbulgingmbackward.mWhat mtypemof mdeformitymof mthem
spinemdoesmshemhave?
AmKyphosis
BmScoliokyphosis
CmScoliosis
DmLordosis
EmGibbus
Answer:
A
Kyphosismismamposteriormconvexmangulationmof mthemthoracicmspinemas mevaluated monmamsidemview.mE
xcessivemand mexaggerated mangulationmresultsminmcosmeticmproblems,mbackmpain, mand mcardio-
mrespiratorymproblems.mKyphosismmaymbempost-traumaticmormnon-
traumaticmtype.mScheuermann'smkyphosis,mpostural,mcongenital,mand mmetabolicmbonemdiseasemarema
mfew mof mthemnon-traumaticmcausesmof mkyphosis.
QUESTION
Am45-year-old mwomanmwithmam25-yearmhistorymof mtypemI mdiabetesmpresentsmformfollow-
upmof mhermdiabetes.mHermspot malbumin/creatininemratiomwasm100mmg/gm4mmonthsmago,mand mit mwasmc
onfirmed mat m100mmg/gmyesterday.mHermurinarymanalysismshowsmnomcells, mcasts,mormblood.mHermcrea
tininemism0.7mg/dl,mand mhermestimated mglomerularmfiltrationmratemism95m ml/min/1.73m2.mHow mwoul
d mhermproteinuriambemdescribed?
AmNormoalbuminuria
BmMicroalbuminuria
CmMinialbuminuria
DmMacroalbuminuria
EmNephroticmsyndrome
,Answer:
B
Screeningmformmicroalbuminuria,mam markermof mkidneymdisease,mism recommended mannuallymformpa
tientsmwithmtypemI mdiabetesmof mgreatermthanm5myearsmduration;mit mismrecommended mannuallymformall
mpatientsmwithmtypemII mdiabetes.mThismscreeningmtest mismmost measilymobtained mwithmamfirst mvoid mm
orningmurinem"spot"malbuminmtomcreatinine mratio.mNormalm levelsmformspot msamplesmarem<10m mg/gm
formmenmand m<15mmg/gmformwomen.mSincemkidneymdiseasesmothermthanmdiabeticmkidneymdiseasemm
aymcausemproteinuriamand malbuminuria,mevaluatingmthemurinemsediment mof mdiabeticsmwithmpresume
d mdiabeticmkidneymdiseasemismadvised.mMinialbuminuriamismnot mamtruemmedicalmterm.
QUESTION
Am55-year-old mwomanmwithmam15-yearmhistorymof mtypemII mdiabetesmpresentsmformfollow-
upmof mhermdiabetes.mHermspot malbumin/creatininemratiomwasm100mmg/gm4m monthsmagomand mwasmco
nfirmed mat m100mmg/gmyesterday.mHermurinarymanalysismshowsmnomcells,mcasts,mor mblood.mHermcreat
ininemism0.7mg/dlmand mhermestimated mglomerularmfiltrationmratemism95mml/min/1.73m2.mWhat mmedi
cation(s)mshould myoumprescribemtomhelpmprevent mhermprogressionmfrom mmicromtommacroalbuminur
iamand mtomhelpmprevent mamprogressivemdeclineminmglomerularmfiltrationmrate?
AmPotassiummchloride
BmCalciummcarbonate
CmLisinopril
DmSodiummbicarbonate
EmCalciummcitrate
Answer:
C
Lisinopril,manmACEmInhibitor,mshould mhelpmdecreasemalbuminuria,mprevent mprogressionmof mdiabetic
mkidneymdiseasemfrommmicromtommacroalbuminuria,mand mprevent mamdecline minmglomerular mfiltration
mrate.mThismclassmof mmedicationsmhasmbeenmstudied mextensivelymformthesempurposes.mAngiotensinmII
mreceptormblockersm(e.g.,mirbesartan)mmaymalsom reducemurinarym albuminmtomnormalm levels.
Monotherapymwithmeithermof mthesemclassesmof mmedicationsmshould mbemattempted mfirst minmpatientsm
withmmicroalbuminuria.mThismwillmtest mtolerance, meffectiveness,mand madversemreactionmsuchmasmhy
perkalemia.mFormpatientsmwithmgreatermdegreesmof malbuminuriam(e.g.,m1mg/day),mpoor mresponsemtom
monotherapymand mblood mpressuremcontrol,mand mnomhyperkalemiamassociated mwithmtherapy,mcombi
nationmtherapymshould mbemconsidered.mCombinationmtherapymwithmbothmACEminhibitorsm(e.g.,mlisi
nopril)mand mangiotensinmII mreceptormblockersm(e.g.,mirbesartan)mismused mtomtreat mbothmdiabeticmand m
non-
diabeticmkidneymdisease.mThesemmedicationsmact monmdifferent mpartsmof mthemreninmangiotensinmsyst
em.mInmcombination,mirbesartanmcould mblockmthemeffect mof mangiotensinmproduced mbymnon-
ACEmpathwaysmand mlisinoprilmcould mblockmthemproductionmof mangiotensinmstimulated mbymirbesart
anminmamnegativemfeedbackmsystem;mhowever,mcombinationmtherapymismusuallympreceded mbymmono
therapy.mAlthoughmcombinationmtherapymismcurrentlymbeingmused minmbothmdiabeticmand mnon-
diabeticmkidneymdisease,mthismtherapymstillmbeingmresearched.mIt mismunknownmwhethermmonothera
pymalonemis
,sufficient.mIt mdoesmnot mappearmtombemsufficient minmallmpatients,mparticularlymthosemwithmpersiste
nt mmicromand mmacroalbuminuriamdespitemmonotherapy.
QUESTION
Am7-year-old mboympresentsmwithmam1-
weekmhistorymof mwheezingmand mdyspneamonmanymexertionm(withmproductivemcough).mOnmphysicalme
xamination,mbilateralmrhonchimaremheard.mAftermamfew mdaysmof mtreatment,mspirometrymismdonemonmt
hempatient.mThemfindingsmaremshownminmthemtable.mTotalmlungmcapacitym(TLC)m ism111%monmspirome
try.mWhat mismthemmost mlikelymdiagnosis?
FVC%mbefore/aftermbronchodilators:m49/63mFEV1
%mbefore/aftermbronchodilators:m41/46mFEV1/FV
Cmbefore/aftermbronchodilators:m49/55
AmAsthma
BmPneumonia
CmPleuralmeffusion
DmKyphoscoliosis
EmTuberculosis
Answer:
A
Themspirometrymresult minmthismpatient mshowsmreductionminmbothmforced mvitalmcapacitym(FVC)mand
mforced mexpiratorymvolumeminm1msecond m(FEV1),mbut mFEV1mismmoremaffected mthanmFVC.mTheref
ore,mtheremismamdecreaseminmthemFEV1/FVCmratiombelow mthempredicted mlevels.mThemTLCmismnorm
alm(80-
m120%).mThismconcludesmthat mthismismanmobstructivemdisordermand mexcludesmthemrestrictivemdiseas
esmlisted.mTheremismammarked mimprovement mwithmbronchodilators.mInmreversiblemairwaymobstructi
onmsuchmasminmasthma,mtheremismamrisem inmthemFEV1mand/ormFVCmbymapproximatelym12% mfrommpr
e-mtompost-
bronchodilatormtesting.mThismreversibilitymismcharacteristicmof mbronchialmasthma. mThe mspirometr
ymfindingsmaremnot msuggestivemof mrestrictivemlungmdiseasesmsuchmasmpneumonia,mpleuralmeffusion
,mkyphoscoliosis,mand mtuberculosis.
QUESTION
Am29-year-
old mwomanminquiresmwhenmshemshould mhavemhermfirst mmammogram.mHermfamilymhistorymismsignifi
cant mformthemdeathmof mhermmothermand mgrandmothermduemtombreast mcancermat mthemagemof m32myears.
mPresently,mthemwomanmismasymptomatic.mWhat mismthemrecommendationmformmammographymformt
hismpatient?
If myoumhavemamstrongmfamilymhistory,mthemNationalmComprehensivemCancermNetworkmrecommends,
mstartingmat magem30,myoumget ma:
Clinicalmbreast mexammeverym6-12mmonths
, MammogrammeverymyearmBrea
st mMRI meverymyear
AmImmediately
BmWhenmshemism30myearsmold
CmWhenmshemism32myearsmold
DmWhenmshemism34myearsmold
EmWhenmshemism36myearsmold
Answer:
A
Breast mcancermismrecognized masmbothmanmincreasinglymcommonmdisordermand mampotentiallymheredita
rymdisorder.mFurthermore,mearlymdetectionmwillmprovidemamwomanmwithmhermbest mchancemat mamcurem
of mbreast mcancer.mGivenmthempatient'smgeneticmburdenmof mhavingmbothmhermmothermand mhermgrandm
othermdiemof mmetastaticmbreast mcancermat mthemrelativelymyoungmagemof m32myears,mit mismreasonablemto
mprovidemhermwithmimmediatemand mperiodicmmammographymcombined mwithminstructionminmbreast m
self-
mexamination.mWomenmat mhighmriskmrequirem ammoremaggressive mschedule,mfrequent mexaminations,
m and mothermproceduresmsuchmasmultrasound mand mMRI.mAmericanmCancermSocietymGuidelines
Womenmagesm40mtom44mshould mhavemthemchoicemtomstart mannualmbreast mcancermscreeningmwithmmam
mogramsmif mtheymwishmtomdomso.
Womenmagem45mtom54mshould mget mmammogramsmeverymyear.
Womenm55mand moldermshould mswitchmtommammogramsmeverym2myearsmormcanmcontinuemyearlymscre
ening.
Screeningmshould mcontinuemasmlongmasmamwomanmisminmgood mhealthmand mismexpected mtomlivem10mmor
emyearsmormlonger.
ThemACSmdoesmnot mrecommend mclinicalmbreast mexaminationmformbreast mcancermscreeningmamo
ngmaverage-riskmwomenmat manymage
ACOG mcontinuesmtomrecommend madherencemtomitsmcurrent mguidelines,mwhichmincludemthemfollowin
g:mScreeningmmammographymeverym1-2myearsmformwomenmaged m40-49myears
Screeningmmammographymeverymyearmformwomenmaged m50myearsmormolder
QUESTION
Am42-year-old mwomanmworksmfull-
timemasmamdatamentrymclerkmand moftenmputsminmmanymhoursmof movertime.mShemhasmstarted mtomnoticem
numbnessmand mtinglingminmhermright mthumb,mindexmfinger,mmiddlemfinger,mand mhalf mof mhermringmfin
ger;msymptomsmaremespeciallymseveremat mnight mThemnumbness mand mtinglingmwerem intermittent mform
months,mbut mtheymhavembecomempersistent mduringmthempast mfew mdays.mWhat mcould mbemconsidered m
ampredisposingmfactormformthismpatient'smcondition?
AmMyxedema
BmHypoadrenalism
CmHypoprolactinemia
DmHypoglycemia
EmCushingmsyndrome
